Provider Demographics
NPI:1336956176
Name:EAGLE ROCK THERAPY
Entity type:Organization
Organization Name:EAGLE ROCK THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-387-1137
Mailing Address - Street 1:2335 FOWLER ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3931
Mailing Address - Country:US
Mailing Address - Phone:425-387-1137
Mailing Address - Fax:
Practice Address - Street 1:2951 US-50 ST. MARY'S BUILDING
Practice Address - Street 2:ROOM 101
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8121
Practice Address - Country:US
Practice Address - Phone:425-387-1137
Practice Address - Fax:719-434-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty